Provider Demographics
NPI:1144337171
Name:JADUS, RONALD (DDS)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:JADUS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 PARK ST
Mailing Address - Street 2:ALICE HYDE DENTAL CLINIC
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-1251
Mailing Address - Country:US
Mailing Address - Phone:518-481-2347
Mailing Address - Fax:
Practice Address - Street 1:134 PARK ST
Practice Address - Street 2:ALICE HYDE DENTAL CLINIC
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-1251
Practice Address - Country:US
Practice Address - Phone:518-481-2347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053713-11223G0001X
TX22245122300000X
CA56797122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist